FIRST UK LIVER TRANSPLANT HISTOPATHOLOGY MEETING 9TH DECEMBER 2008

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First UK Liver Transplant Histopathology Meeting

9^th December 2008

St Thomas’s Hospital, London

Eleven pathologists including at least one from each of the eight transplant centres was able to attend the meeting. The first half of the meeting was a round table discussion, and the second half a multi-header discussion of previously circulated slides.

1-2pm – meet with sandwich lunch,

2pm: Providing the service: -

Round table – each centre – how do we do it?

- who are the pathologists?

- why biopsy? – time 0, protocol,

Just for diagnosis of clinical/biochemical abnormality

- when? - arrangements for out of hours cover

- post transplant biopsies

- donor frozen sections

Introduction and discussion of service provision, summarised in the table below.:

names in italics = pathologists at this meeting:

	Pathologists and emails	Protocol biopsies	Out-of-hours – frozen section and Tx biopsy
Birmingham	Stefan Hubscher Desley Neil Rachel Brown	Post-reperfusion Hep C yearly Others – about 1,3,5 & 10 years	No on-call rota Switchboard has consultant numbers. F/S donor lesion – usually done early morning. No technical rota out of hours
Edinburgh	Chris Bellamy David Harrison	Hep C yearly No other protocol Bxs Prev Time 0, not now	Share 1 in 2, occasional gaps Rapid 1 hour processing and formal technical rota funded. Renal&liver Tx cover relatively frequent Bx ½ weekends, donor lesion F/S about 1/month
King’s	Bernard Portmann Alberto Quaglia Alex Knisely	Post-reperfusion One year (all patients?) Children 10 years	1 in 3 24 hour on call, often used for donor F/S no technical support – cut their own F/S. No out of hours Tx biopsy – Friday afternoon or Monday morning
Dublin	Niamh Nolan Susan Kennedy Ciaran Sheehan Tom Crotty	Time 0 – all patients No other protocol Bxs	1 in 4 on call for all histology- most Saturdays, some Sundays, F/S about 1/month. Informal technical staff rota. Different payment arrangements in Ireland
Royal Free	Paul Dhillon Frederica Grillo Jennifer Watkins	Time 0 – about 50% Before discharge (?%) Hep C yearly	1/7 rota for donor lesions F/S with formal technician on call
Leeds	Judy Wyatt Darren Treanor Olorunda Rotimi	Hep C yearly Children at 5 years	Tx Bx 1 in 3 rota, mainly Sat mornings, possible other times F/S donor lesions 1/10 rota Formal technician on call
Newcastle	Alastair Burt Beatte Haugk Alan Patterson	Time 0 nearly all No other protocol Bxs	1 in 7 in group that covers liver/heart/lung, formal on call for donor lesion F/S. Tx biopsies – not weekend but do bank holidays
Cambridge	Susan Davies Rebecca Brais ?Satina Theroux?	Time 0 – all patients Hep C 6 months then annually	Donor lesion F/s all pathologists take part in rota, guide management, not definitive diagnosis. Separate liver Tx biopsy rota, shared by 3.

6/8 do time 0 biopsies (Edinburgh recently stopped)

5/8 do hep C annual biopsies

Other general discussion about service delivery:

Out of hours is a requirement for transplant programme/commissioning (PD, SD)
Potential use of Aperio in future for covering service for another centre, second opinion on Tx Bx etc.
Donor frozen section for fat – no evidence on a threshold for what is ‘too fatty’ for cadaveric grafts. Estimates refer to macrovesicular steatosis, not microvesicular (= small droplets rather than ‘invisible’ fat) which accumulates during preservation (DN). Impression that histology is used to justify a decision already taken not to use a graft. Can use a graticule or set of images to standardise assessment of fat (CB, figure attached).

Circulated cases – get scanned and ask for commentaries +/- photo of relevant special stains

Collated responses attached.

Review of afternoon meeting:

Agreed that this was valuable and should be continued on a yearly basis, linked to the UK & Ireland liver transplant meeting, which rotates around the country.
The local pathologists will be the local organisers.
Slide circulation will preceed meeting – sent out 3 weeks in advance, organised through EQA support team
One case per centre, possibility of following a theme in future meetings
Digital images also available – include special stains in future.
Multi-header discussion valuable, preferred to microscope slide projection, powerpoint images acceptable failing either of the others. Will need to book large enough multiheader early to ensure availability.
Potential for including pathology in the main meeting next day – at discretion of local organisers.

JIW

18/12.08

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